中国基层医生医疗服务能力现状与对策研究

Current Situation and Countermeasure of Medical Service Capacity of Primary Care Physicians in China

背景 随着“强基层”措施的推进,中国基层医疗卫生专业人员数量已得到较大增长,但基层医生的医疗服务能力与居民的基本医疗需求仍有差距。目的 了解我国不同地区、城乡间基层医生医疗服务能力的现状,探讨提升中国基层医生医疗服务能力的策略。方法 于2020年8月,采用多阶段分层抽样与典型抽样相结合的方法对中国东、中、西部基层医疗卫生机构的8 537名医生开展线上问卷调查,使用课题组既往开发的基层医生卫生服务能力指标体系,选取其中医疗服务部分的指标为依据设计调查问卷,从常见病、多发病诊治,危急重症应急处置,医疗服务协同及中医药服务4个方面评价基层医生医疗服务能力的具备情况、满足工作需要情况。比较不同地区、机构层级基层医生医疗服务能力具备情况和满足工作需要情况的差异。结果 调查共回收有效问卷8 469份,问卷的有效回收率为99.2%。有6 954名(82.1%)、4 283名(50.6%)、4 800名(56.7%)、4 464名(52.7%)基层医生具备常见病、多发病诊治,危急重症应急处置,医疗服务协同以及中医药服务能力。在医疗服务能力具备率方面,地区分布上,中部地区基层医生各项医疗服务能力具备率均高于东、西部地区(P<0.017);在机构层级上,除常见病、多发病诊治能力以外,农村地区基层医生各项医疗服务能力具备率均高于城市地区(P<0.05),村卫生室基层医生危急重症应急处置能力、中医药服务能力具备率高于社区卫生服务中心和乡镇卫生院(P<0.005)。在基层医生医疗服务能力满足工作需要率方面,基层医生常见病、多发病诊治能力,医疗服务协同能力,危急重症应急处置服务能力,中医药服务能力的满足工作需要率分别为97.2%(4 233/4 357)、96.2%(4 269/4 436)、95.2%(3 227/3 388)、92.3%(3 954/4 284);东部地区基层医生医疗服务能力满足工作需要率高于中部和西部地区,城市地区高于农村地区(P<0.05),且社区卫生服务中心高于村卫生室(P<0.005)。结论 目前中国基层医生团队中高素质人才缺乏,基层医生危急重症应急处置,医疗服务协同以及中医药服务能力仍有待加强,中部地区、农村地区和村卫生室基层医生医疗服务能力具备率整体较高,但满足工作需要率较低,需要针对各地区医疗能力的短板,从完善政策和培训方式等方面因地制宜地对各地基层医生给予更多支持。

Background With the promotion of"strengthening the primary care"measures,the number of primary healthcare professionals in China has increased significantly,but there is still a gap between the capacity of primary care physicians and basic medical needs of residents.Objective To understand the current situation of the medical service capacity of primary care physicians in different regions and between urban and rural areas of China,explore the strategies to improve the medical service capacity of primary care physicians in China.Methods In August 2020,an online questionnaire survey on 8537 primary care physicians in the primary care institutions in eastern,central and western China by using the method of multi-stage stratified sampling combined with typical sampling.The questionnaire was designed based on the indexes in the part of medical service of the medical service capacity evaluation tool of primary care physicians previously developed by the research group,which was used to evaluate the competence of primary care physicians in four aspects of diagnosis and treatment of common diseases and frequent diseases,emergency treatment of critical illnesses,medical service coordination and traditional Chinese medicine services and assess the extent to which their competence met the needs of their work.The competence of primary care physicians and the extent to which their competence met the needs of their work were compared in different regions and levels of medical institutions.Results A total of 8469 valid questionnaires were collected,with the recovery rate of 99.2%.There were 6954(82.1%),4283(50.6%),4800(56.7%)and 4464(52.7%)primary care physicians who had the ability of diagnosis and treatment of common diseases and frequent diseases,emergency treatment of critical illnesses,medical service coordination and traditional Chinese medicine services.The rate of medical competence of primary care physicians in the central region were higher than those in the eastern and western regions from the perspective of regional distribution,with statistically significant differences(P<0.017);there were significant differences in the rate of medical competence of primary care physicians between rural and urban areas from the perspective of institutional level(P<0.05).Except for diagnosis and treatment of common diseases and frequent diseases,the rates of medical competence of other medical services of the primary care physicians in the rural area were higher than those in the urban area(P<0.05),the medical competence rates of emergency treatment of critical illnesses and traditional Chinese medicine services of primary care physicians in village clinics were higher than those in community health service centers and township hospitals,with statistically significant difference(P<0.005).In terms of the rate of ability to meet work needs,the rates of primary care physicians were 97.2%(4233/4357),96.2%(4269/4436),95.2%(3227/3388),92.3%(3954/4284)in diagnosis and treatment of common diseases and frequent diseases,emergency treatment of critical illnesses,medical service coordination and traditional Chinese medicine services;the rate of primary care physicians was higher in the eastern region than in the central and western regions(P<0.017),higher in urban areas than in rural areas(P<0.05),and higher in community health service centers than in village clinics(P<0.005),with statistically significant differences.Conclusion There is a shortage of high-quality personnel in the team of primary care physicians in China.The abilities of emergency treatment of critical illnesses,medical service coordination and traditional Chinese medicine services still needs to be strengthened.The overall rate of medical competence of primary care physicians in the central region,rural areas and village clinics is high,but the rate of ability to meet work needs is low.It is necessary to provide more support to primary care physicians in each region in terms of improving policies and training methods in accordance with local conditions.